Spleen

From Wang Kentang and Wu Mianxue, The Compendium of Traditional Diagnosis (Gu Jin Yitong Zhengmai Quanshu), 1601: The stomach is called the sea of grain and water; everything is assimilated here. The spleen is in charge of transportation; everything is moved by its workings. Absorbing and moving: these are the essential actions which define the spleen/stomach network as the main source of the life-sustaining postnatal energy. From Li Zhongzi, A Primer of Medical Objectives (Yizong Bidu), 1637: What makes the spleen the source of postnatal energy? Once a child has been born, it will feel hungry after one day without food, and it will die after seven days without food. Once we have entered the realm of the physical body, therefore, we have to be nourished by qi that is derived from food (gu qi). Once the food enters the stomach, it is transported to the six fu organs, and thus there will be qi. It will be appropriately dispensed to the five zang organs, and thus there will be blood. Human beings must rely on this type of nourishment in order to stay alive. It is for this reason that the spleen is called the source of postnatal energy. From Cheng Wenyou, Quotes from Medicine (Yishu), 1826: Be aware that the spleen network cannot be compared to a system of mills or mortars that grind or pound away on the incoming food. Rather, the spleen's ability to transform food and drink primarily depends on its suctioning affect: preventing the

food from falling down! Every food item entering the stomach consists of both a qi component and a material component. The material component of the food naturally sinks downwards, while its qi component naturally rises upwards. Once in the stomach, the food gets "steamed" under the influence of stomach qi. Then, in the process of being separated into its material and its light parts, it is being suctioned by the qi of the neighboring spleen. In this fashion, the stomach qi is being assisted in its vital work and all of the food essence remains where it needs to be for processing-all the way until every bit of food qi has been extracted and only the material shell remains, at which time the lower gate of the stomach opens and the dregs are being discarded downwards. From Li Dongyuan, A Treatise on the Spleen and Stomach (Piwei Lun), 1249: The stomach is called the sea of grain and water. Once food enters the stomach, its essential energy is moved upwards to infuse first the spleen and then the lung. In this fashion, the command of spring and summer is being carried out, and the entire body receives nourishment. This is due to the influence of clear heavenly qi. Once the ascending motion has reached its climax, this current shifts directions and flows downwards toward the bladder. In this fashion, the command of autumn and winter is being carried out, and the waste becomes processed and the flavors will manifest. This is due to the influence of turbid earth qi. If we then regulate our daily lives by adjusting them to the prevailing energy of the seasons, if we avoid exposure to extreme cold and extreme heat, if we eat and drink in regular intervals, if we protect our shen by avoiding states of extreme anger or extreme ecstasy, and if we strive for balance by living in moderation during all four seasons, there will be peace. Otherwise, the spleen and stomach will suffer harm, and our true qi will leak downward in trickles or currents [i.e., diarrhea], with the possibility of failing to rise again. This, then, would be like having autumn and winter but no spring and summer, and a situation would arise in which the functions of birth and growth are muffled by the qi of death and extinction. Naturally, all kinds of diseases would arise from such a situation. At the same time it is without question that if there was only rising and no descending momentum within the body there would be disease. From Yu Chang, The Statutes of Medicine (Yimen Falü), 1658: Both the zang and the fu organ networks depend primarily on the spleen and the stomach. All food we eat enters the stomach and is then transported by the spleen, just like the dirt on earth [is distributed by wind and water to nourish all life forms]. It should be pointed out, however, that the spleen/stomach's capability of transforming the food is actually dependent on the two essential qualities of fire and water. The spleen and stomach cannot do this by themselves. When fire is in a state of excess, the spleen and stomach will be dry; when water is in a state of excess, the spleen and stomach will be damp. Either situation will cause the hundred diseases to arise. From Yang Jizhou, The Great Compendium of Acupuncture and Moxibustion (Zhenjiu Dacheng), ca. 1590; listed in the spleen channel section as a quote from an older Daoist source, The Original Classic of Guiding the Breath (Daoyin Benjing) :

The spleen is situated at the center of the five organ networks. Therefore, it is assigned to no particular season but flourishes during all four seasons. It contains and fosters the five flavors, it brings about the five mental faculties, and it moves the four extremities and the one hundred marrows. As soon as there is irregular intake of food and drink or overexertion of any kind, the spleen qi will be harmed. As soon as the spleen and stomach suffer damage, food and drink stagnate and do not transform: the mouth loses its ability to distinguish flavors, the extremities feel limp and tired, discomfort and distention is felt in the stomach and abdominal regions, symptoms of vomiting and diarrhea appear, and there may be dysentery or a host of other symptoms which have been specified in the Neijing and other books, and which can be looked up there. If we therefore force ourselves to eat when we are not hungry, the spleen will suffer. If we force ourselves to drink when we are not thirsty, the stomach will bloat. If we eat beyond capacity, the vessels in which the qi circulates will become obstructed, and the body's center (stomach region) will become jammed and shut off. If we eat too little, on the other hand, the body will become emaciated, the stomach will grow anxious, and our thoughts will become unsteady. If we eat contaminated food, the heart's ability to differentiate will become blurred, and we will grow more and more restless. If we eat things that we should not eat, the four great upheavals will occur and bring along disease. None of these types of behavior represents the way of good health. Therefore, it is most important to consume our food at the appropriate time, to drink our fluids in regular intervals, and to avoid both overeating and hunger pains. If we eat and drink according to these simple guidelines, then not only the spleen/stomach network itself will remain unspoiled and function perfectly, but also the five zang and the six fu organ networks will all be in a harmonious state of health. After food and drink enter the mouth, they pass through the epigastric region into the stomach. From the stomach, the immaterial flavors contained in the food penetrate the five organs, whereas the material components enter the small intestine where they are further transformed. When they reach the lower opening of the small intestine, the first stage of the process of separating clear and murky materials occurs. Murky materials are the waste, to be passed on to the large intestine. The clear materials are the source of all bodily fluids; they enter the bladder which is called the store house of fluids. In the bladder, once again a separation of pure and murky materials takes place. The murky debris goes into the urine to be excreted, while the clear material enters the gallbladder. The gallbladder, finally, guides this purified fluid essence to the spleen which dispenses it to the five organ networks; they, in turn, utilize it to produce digestive saliva, nourishing saliva, nasal discharge, tears, and sweat. The flavors, meanwhile, penetrate the five organs and transform into the five types of essential dew, which return to the spleen where they are transformed into blood. In the form of nourishing blood, finally, they are returned to the organs. The Classic states: "When the spleen is healthy it can generate all living things. If it becomes depleted, it can bring about the hundred diseases." The ancient poet, politician, and medical scholar Su Dongpo (1037-1101) used to harmonize the spleen by moderating food intake, even when there was enough money to eat lots. Therefore,

I wish to extend the following advice to people who are in the habit of throwing lavish banquets: derive happiness from internal peace; always leave room in your stomach, so you can nourish your qi; and spend less if you wish to increase your material wealth. The healthy person maintains the inside, while the unhealthy person maintains the outside. The person who maintains the inside pacifies his/her zang and fu organ networks, and thus causes the blood in the vessels to flow smoothly and uninhibited. The person who maintains the outside indulges in dazzling flavors and luxuriant culinary delights; albeit at first glance the body of such a person may appear strong and sturdy, a fierce verminous qi is corroding the zang and fu organs inside.

The stomach is in charge of receiving food and drink via the mouth and esophagus, containing them, and finally fermenting them. The stomach is therefore called the "sea of grain and water." After "grinding and fermenting" the incoming materials part of the essence distilled from food is passed on to the spleen, while the rest is passed on downwards to the small intestine. If the stomach fails to receive and ferment properly, the supply of postnatal qi to the other organ networks will be disturbed. Master Hua's Classic of the Central Viscera states: "If the stomach qi is strong, all of the five zang and the six fu networks will be strong."

The spleen is in charge of the transformation and distribution of food essence and fluids, as well as the transformation of pathological dampness. A healthy spleen will facilitate the optimal absorption and distribution of essence. Consequently, the entire body will be provided with the nutrients that are essential for survival. It is for this reason that the spleen has been labeled the postnatal root of life. If there is proper absorption and transformation of food essence, the food will turn into refined essence rather than into "damp" slush stagnating in the digestive tract. Conversely, the presence of dampness in the system will severely hamper the transformative actions of the spleen. Part of the spleen's transporting function, moreover, is to move fluids upwards to the lung, from where they are "sprinkled" over the entire body to ensure proper moisturization. If this basic metabolism of fluids can function undisturbed, no buildup of pathological dampness will occur within the system.

The crucial transporting function of the spleen is entirely based on its action of "raising the pure (essence)." This means that in its physiological state the spleen qi exhibits a rising momentum. If the spleen qi rises, a "transporting" affect will ensue.

On the other hand, the equally important action of passing on of the dregs-and the continued differentiation of pure and turbid fluids-are a result of the stomach's downward momentum, generally referred to as "descending the turbid." Fluid differentiation and absorption is achieved cooperatively by the small intestine, the triple warmer, and the bladder, but these aspects of fluid metabolism are often attributed, simply, to the descending function of the stomach. The influential Treatise on the Spleen and Stomach (Pi Wei Lun), written by the Yuan Dynasty medical authority Li Dongyuan, strongly underscores the rising function of the spleen. To clarify his point, Li refers to the workings of nature. He reminds his readers that the human body is a miniature replica of the surrounding macrocosm. All phenomena on earth, the Treatise points out, are produced by the intercourse of ascending earthly and descending heavenly qi. The upward momentum of the essence qi, propelled by the spleen, can be compared to the clear yang of nature which ascends toward heaven until it congeals into clouds in the sky. The ethereal part of this essence (the yang within yang) purifies and nourishes lung qi, thus maintaining an atmosphere of moistness, freshness, and clarity in the upper burner (which affects the sensory orifices of the ears, eyes, mouth, and nose). The denser portion of this ascending yang substance (the yin within yang) moistens the skin, strengthens the pores, and gives firmness to the limbs. And just as the turbid yin in nature condenses below to form earth, the Treatise goes on to explain, the clear essence of the turbid yin derived from food (the yang within yin) "turns red" and transforms into blood, thus nourishing the body, while the dregs and superfluous fluids are excreted. The turbid part of the turbid (the yin within yin), finally, forms the material basis for the bone marrow. The Qing Dynasty essay collection, Spontaneous Thoughts Inspired by Reading the Medical Classics (Duyi Suibi), summarizes this pivotal role of the spleen/stomach by drawing a Taiji (yin-yang symbol) of bodily waxing and waning: "The heart and the lung are yang; as they follow the downward impulse of stomach qi and descend on the right, they transform into yin. The liver and the kidney are yin; as they follow the upward impulse of spleen qi and ascend on the left, they transform into yang."

The hollow stomach is in charge of "fermenting and ripening" incoming food. The character wei (stomach) reflects the stomach's likeness to a high altitude field. Since fields in higher locations are closer to the sun and their moisture can easily drain downwards, their earth has a tendency to get dry, earning it the designation "yang earth." As the yang earth of the body, the stomach is known to easily become dry. The spleen, among other things, is in charge of transforming dampness. The character pi (spleen) reflects the spleen's likeness to a low-altitude field. Like the earth at the bottom of a valley, the spleen has a tendency to become damp, and is thus known as "yin earth."

The ideal milieu for their functioning is slight moistness for the stomach and near dryness for the spleen; that is the exact opposite of their natural tendencies, so the spleen and stomach must rely on each other to achieve a state of balance. Otherwise, the drying action of the stomach may fail to control spleen damp, and signs of stagnant water accumulation in the system will arise. Or the moistening quality of the spleen may fail to nourish the dry stomach, and symptoms of thirst, voracious appetite, or other signs of stomach heat will appear.

Although it is primarily the lung which governs bodily qi, and primarily the heart which governs blood, the spleen is the physical earth center which is the source of both the body's qi and blood. Both of these vital substances are considered to be transformations of food essence.

Qi does not only move body essences, but it also holds them in place. The fact that the blood circulates in the vessels without leaving its proper path is particularly attributed to the restraining function of spleen qi. The Classic of Difficulties (Nanjing) simply states: "The spleen contains the blood [pi tong xue]" This function of the spleen [associated with the earth element or phase] is evocative of the characteristics of earth: just as the rivers and streams are contained by an earthen bed, the body's blood is contained in the channels.

The absorbing and transporting function of the spleen/stomach is directly reflected in the development of a person's flesh and muscles. Strong and well developed arms and legs are therefore considered to be an important indicator for good spleen function. Weak, cold, painful, obese, or malformed arms and legs are a primary sign of spleen weakness.

The condition of the spleen manifests in the flesh of the mouth-the lips. Bright red lips, for instance, may indicate damp heat in the stomach. Chronic gum bleeding or structural changes of the gums may arise from spleen deficiency, while symptoms of severe dryness in the mouth, gum swelling, tooth aches, or severe hemorrhaging may be the result of a stomach excess (heat, dryness) condition. Structural pathologies in the oral cavity (including tongue shape and tongue coating) and unusual taste sensations in the mouth (or lack thereof) are almost always indicative of spleen/stomach disturbances.

The mental processes of thinking and remembering are considered to be part of the physiological activity of the spleen. A person with a poor digestive system usually cannot think clearly. This is because clear yang energy fails to rise up to the heart and brain, or because of accumulating dampness clouding the orifices. As always, this relationship also works the other way around: if a person thinks or worries too much, this can easily lead to digestive symptoms such as poor appetite, diarrhea, or constipation.

The Spleen/Stomach Is Unable to Absorb, Transform, and Transport: If stomach qi becomes injured, the stomach loses its ability to contain food, and the person will exhibit symptoms of aversion to food or drink, nausea and vomiting, hiccuping, or frequent belching. If the spleen loses its ability to transform and transport the essence of food, abdominal distention, loose stools or diarrhea, fatigue, or emaciation may occur. Also, if the spleen loses its ability to transport fluids and transform dampness, internal dampness and phlegm will accumulate, potentially manifesting in a variety of phlegm disorders, diarrhea, or edema. The Balance Between Raising the Clear and Descending the Turbid is Disturbed: If the stomach's turbid substances do not descend, but push upwards instead, there will be symptoms of distention, vomiting, hiccuping, or belching of foul gases or sour liquids. If "the clear" cannot be properly raised upwards by the spleen, typical symptoms that may result are diarrhea, prolapse of the stomach, prolapse of the anus, or prolapse of the uterus/vagina. Collected Sayings by Dr. Wu (Wu Yi Hui Jiang) pointed out: "Among the many therapeutic approaches to spleen and stomach disorders, none is superior to harmonizing the dynamics of raising and descending." Imbalance of Dryness and Dampness: If dampness hampers the free unfolding of spleen yang and thus the spleen's transporting ability, the stomach function will immediately be affected and symptoms of poor appetite or nausea will result. On the other hand, if there is excessive heat and dryness present in the stomach, this condition will in turn influence the function of the spleen: fluids will be scorched, resulting in constipation; or the spleen yang may collapse downward, causing symptoms of fatigue, constant sleepiness, frail extremities, diarrhea, and a slow pulse. Stomach Disorder Influencing the Six Fu Organs: If there is dry heat in the stomach, it scorches the body's fluids; as a result, there will be constipation, and the transporting function of the large intestine will become severely inhibited. Damp heat in the spleen/stomach "steaming" the neighboring gallbladder can cause the bile to overflow and produce jaundice. Downpouring of damp heat from the spleen/stomach can have a detrimental effect on the triple warmer, the small intestine, and the bladder, and thus cause symptoms of dark and burning urination or dribbling urinary block. In the stomach itself, dry heat or food stagnation usually cause a loss of descending

action, manifesting as epigastric stuffiness, vomiting, belching, acid regurgitation, abdominal distention, or constipation. The Spleen Cannot Contain the Blood within the Vessels: If spleen qi decreases in strength, a loss of the spleen's function of containing the blood within the vessels may result. Various types of bleeding are thus sometimes associated with a deficiency of spleen qi, particularly recurrent hematomas, certain types of purpura, and prolonged menstrual bleeding. Since spleen-related hemorrhaging is always caused by a deficiency syndrome and usually involves slow leakage of pale blood, it should not be confused with the acute loss of profuse amounts of dark red blood caused by blood heat. Unbalanced Mental Activity Harming the Spleen: If a person is involved in excessive worrying, thinking in pensive circles that lead nowhere, or simply has a mental focus that is too narrow or too intense, spleen symptoms such as loss of appetite, general exhaustion, or inhibited qi flow (causing insomnia, sleepiness, or lack of vision and mental clarity) may gradually manifest. Mental and Physical Exhaustion Taking Their Toll on the Spleen: Ancient Chinese texts place particular emphasis on the fact that any exertion beyond one's individual limits will result in injury to the qi of the spleen/stomach. If a person is not allowed to recover from extreme exhaustion, there may be permanent weakness and fatigue, shallow breathing and a decreased desire to talk, heat sensations and spontaneous sweating, or asthmatic breathing that comes on with even slight physical exertion. In Neijing terms: "Exertion fritters away the qi." The Spleen Is Unable to Govern the Flesh and the Muscles: Prolonged sitting or lying down is said to harm the spleen, and thus cause atrophy of the muscles. Since the spleen governs the flesh layer, all disorders such as a heavy and sore body, slow healing wounds, bed sores, emaciated arms and legs, the weak extremities of the chronically bed-ridden patient, and certain types of paralysis are results of spleen injury. Spleen Disorder Affecting Changes in Appetite and Taste Sensation: A poor appetite, the feeling that "everything tastes like nothing," a voracious appetite, sugar cravings, or other pathological changes in appetite or taste sensation usually involve the spleen/stomach network. As the respective chapter in the historic reference work, An Illustrated Encyclopedia (Tushu Bian), explains: "Poor appetite is a sign of acute food stagnation or injury to the spleen/stomach. If the patient is hungry, but cannot get much of the food down, this is a sign of cold pathogens in the spleen. If a person craves sweets, this is a sign of spleen deficiency."

Tonify the spleen (with bland/sweet flavors) (bu pi; gan dan shi pi): dioscorea (shanyao), hoelen (fuling), lotus seed (lianzi), euryale (qianshi), coix (yiyiren), dolichos (biandou).

Build the center and uplift qi (jian zhong yi qi): codonopsis (dangshen), atractylodes (baizhu), astragalus (huangqi), jujube (dazao). Warm the spleen (wen pi): dry ginger (ganjiang), evodia (wuzhuyu), black pepper (hujiao), zanthoxylum (shujiao). Move the spleen (yun pi): red atractylodes (cangzhu), magnolia bark (houpo), cardamon (sharen), amomum (baidoukou). Harmonize the center and regulate qi (li qi): citrus (chenpi), saussurea (muxiang), agastache (huoxiang), perilla stalk (sugeng), clove (dingxiang), galanga (gaoliangjiang). Emolliate acute central distress (huan ji): licorice (gancao), jujube (dazao), honey (fengmi). Raise central yang and lift collapse (sheng yang ju xian): cimicifuga (shengma), pueraria (gegen), astragalus (huangqi). Dry damp (zao shi): red atractylodes (cangzhu), tsao-kuo (caoguo), cardamon (sharen), pinellia (banxia). Transform phlegm (hua tan): citrus (chenpi), pinellia (banxia), bamboo skin (zhuru), bamboo resin (tianzhuhuang), bamboo sap (zhuli), sinapis (baijiezi), arisaema (tiannanxing). Percolate damp (shen shi): hoelen (fuling), coix (yiyiren). Disinhibit damp (li shi): polyporus (zhuling), alisma (zexie), akebia (mutong), capillaris (yinchen), polygonum (bianxu). Drive out water rheum (zhu yin): zanthoxylum seed (jiaomu), atractylodes (baizhu), euphorbia (daji), daphne (yuanhua), kan-sui (gansui), phytolacca (shanglu). Nourish stomach yin (yang wei yin): ophiopogon (maimendong), yu-chu (yuzhu), trichosanthes root (tianhuafen), dendrobium (shihu). Clear stomach heat (qing wei re): gypsum (shigao), coptis (huanglian). Purge stomach fire (xie wei huo): rhubarb (dahuang), mirabilitum (mangxiao). Dissolve food accumulation (xiao dao): crataegus (shanzha), shen-chu (shenqu), malt (maiya), gallus (jineijin), chih-ko (zhike), raphanus (laifuzi). Harmonize the stomach and descend rebellious qi (he wei jiang ni): fresh ginger (shengjiang), pinellia (banxia), clove (dingxiang), agastache (huoxiang), hematite (daizheshi). Control acid (zhi suan): evodia (wuzhuyu), coptis (huanglian), cardamon (sharen), fritillaria (zhe beimu), cuttlefish bone (wuzegu), calcined oyster shell (duan muli).

Just as the earth assumes the position of centeredness, balance, and harmony in nature, the spleen/stomach network is the body's center of balance. All up and down movements pivot around it, and both damp and dry qualities come together here to form a physiologically beneficial alliance. As the main text of the fever school, Wenbing Tiaobian, points out: "The spleen should be treated like the beam of a scale: if it is not in horizontal balance, it will not be at peace." Treating the spleen/stomach also requires the use of substances that are harmoniously balanced. Foods and herbs that are overly hot or cold or dry or moistening should be avoided. As a general rule, spleen disorders are usually of a deficient nature, requiring the tonification of central qi and the stimulation of the ascending movement of clear yang qi. Stomach disorders, though they may be based on deficient functions, usually involve excess or accumulation problems; accumulation needs to be dissolved and guided out. Since the functioning of both the spleen and the stomach are closely tied to their respective directional momentum, proper qi movement needs to be restored in case of erratic movement. If the upwardly mobile spleen yang collapses downward (diarrhea, organ prolapse, etc.), it should be lifted by employing measures that tonify the spleen and boost central qi. If the stomach's descending motion is upset, as is the case with rebellious stomach qi (nausea, vomiting, etc.), the situation should be rectified by harmonizing the stomach and descending the rebellious qi. Herbs that eliminate pathological dampness are common spleen therapies, including bitter herbs that dry damp, bland herbs that percolate damp, and spicy herbs that break down and eliminate phlegm and other types of pathological liquid. The stomach is often treated with substances that nourish and protect its physiological fluids: sweet and cold herbs that moisten dryness; salty and cold herbs that clear stomach heat; and herbs that protect its yin by clearing stomach heat, cleansing stomach fire, or in severe cases, effecting emetic or purgative action. As the principal flavor of harmony, sweet has a primary affinity to the earth network. Therefore, if the spleen is in acute distress, sweet flavors can harmonize the spleen and be beneficial to the production of central qi. As the Neijing points out: "Sweet generates the spleen." If sweet foods are used excessively, however, they will produce phlegm, obstruct transformation, and harm the flesh layer that is associated with the spleen. Swelling, bloating, and obesity will result. Again, this fundamental principle has been recorded by the Neijing, stating that "sweet harms the flesh," and "if the disease is in the flesh layer, the patient should abstain from the excessive consumption of sweet flavors." When treating spleen/stomach disorders, the system's relationship to other organ networks needs to be taken into consideration. Particularly the liver's overbearing influence needs to be corrected if it is the original cause for the spleen's distress. Spleen tonics are therefore often accompanied by herbs that smooth and emolliate the liver.

SPLEEN QI DEFICIENCY (pi qi xu): primary symptoms include decreased appetite; sallow complexion; fatigue; shallow breathing or shortness of breath; little desire to talk; epigastric and/or abdominal bloating (especially after eating); loose or unformed bowel movements. Secondary symptoms may include weak or emaciated extremities; edematous extremities; inhibited urination; decreased amount of (pale colored) menstrual flow. The tongue typically manifests with a pale body, toothmarks, and a thin white coating; the pulse tends to be weak and slow. Representative Herbs: codonopsis (dangshen), astragalus (huangqi), atractylodes (baizhu), hoelen (fuling), dioscorea (shanyao), lotus seed (lianzi), coix (yiyiren), dolichos (biandou), jujube (dazao); citrus (chenpi), shen-chu (shenqu). Representative Formulas: Four Major Herbs Combination (Si Junzi Tang); Six Major Herbs Combination (Liu Junzi Tang). DOWNWARD COLLAPSE OF SPLEEN QI (pi qi xia xian): primary symptoms include weak voice; shortness of breath; fatigue; bloating sensation right after eating; prolapsing sensation in stomach and abdomen (wan fu zhong duo); (bianyi pinshuo); or possibly prolapse of anus due to chronic diarrhea; or prolapse of stomach or uterus. Secondary symptoms may include dizziness; unclear sensory perception (especially blurry vision); poor appetite; spontaneous sweating; mental and physical fatigue; diarrhea. The tongue typically presents with a pale body and a thin white coating; the pulse tends to be weak and empty. Representative Herbs: astragalus (huangqi), codonopsis (dangshen), atractylodes (baizhu), dioscorea (shanyao), dolichos (biandou), cimicifuga (shengma), pueraria (gegen); bupleurum (chaihu), citrus (chenpi). Representative Formula: Ginseng and Astragalus Combination (Buzhong Yiqi Tang). STOMACH YIN DEFICIENCY (wei yin xu): primary symptoms include dry lips; frequent thirst sensation; dry throat; sticky sensation in the mouth; poor appetite; sensation of emptiness, stuckness, or pain in epigastric region. Secondary symptoms may include hunger sensation without desire for food; constipation; restlessness; sensations of surging heat. The tongue typically presents with a red body and a mirror surface without coating, or with a red body and little coating, or with a dry tongue and little moisture; the pulse tends to be fine and rapid. Representative Herbs: glehnia (bei shashen), ophiopogon (maimendong), yu-chu (yuzhu), dendrobium (shihu), raw rehmannia (sheng dihuang), trichosanthes root (tianhuafen), Asian pear juice (li zhi), sugar cane juice (ganzhe zhi); bamboo skin (zhuru). Representative Formulas: Glehnia and Ophiopogon Formula (Shashen Maidong Yin), Boost the Stomach Decoction (Yiwei Tang).

SPLEEN YANG DEFICIENCY (pi yang xu): primary symptoms are spleen qi deficiency symptoms with an emphasis on cold signs, such as abdominal pain that improves with the application of heat and pressure; cold extremities; poor appetite; abdominal bloating; loose or unformed stools. Secondary symptoms include decreased taste sensation; little desire to drink; edematous extremities; inhibited urination; increased amounts of clear vaginal discharge. The tongue typically presents with a pale and tender body and a white and slippery coating; the pulse tends to be deep and fine, or deep and slow. Representative Herbs: dry ginger (ganjiang), aconite (fuzi), evodia (wuzhuyu), zanthoxylum (chuanjiao), clove (dingxiang), atractylodes (baizhu), codonopsis (dangshen). Representative Formulas: Ginseng and Ginger Combination (Lizhong Tang), Fill the Spleen Formula; Magnolia and Atractylodes Combination (Shipi Yin). COLD DAMP OBSTRUCTING THE SPLEEN (han shi kun pi): primary symptoms are a general sense of heaviness in the body and/or the head; discomfort or bloating in the abdomen or epigastric region; reduced taste sensation; little or no thirst; abdominal pain; unformed stools or diarrhea. Secondary symptoms include no appetite; nausea and vomiting; sticky sensation in mouth; puffy face; edematous extremities; bags under the eyes; increased vaginal discharge. The tongue is typically fat and has a greasy white coating; the pulse tends to be soft and moderate. Representative Herbs: red atractylodes (cangzhu), atractylodes (baizhu), hoelen (fuling), magnolia bark (houpo), citrus (chenpi), pinellia (banxia), tsao-kuo (caoguo), agastache (huoxiang), (peilan), perilla stalk ( zi sugeng). Representative Formulas: Magnolia and Citrus Combination (Pingwei San); Magnolia and Hoelen Combination (Wei Ling Tang). DAMP HEAT IMPLICATING THE SPLEEN (shi re yun pi): primary symptoms are stuffy sensation in the subcostal and epigastric regions; abdominal bloating; poor appetite; dry and sticky sensation in mouth; aversion to greasy foods; nausea and vomiting; general sensation of heaviness; jaundiced eyes and face. Secondary symptoms may be body itch; fever; dark and scanty urination; obstructed bowel movements. The tongue typically presents with a greasy and yellow coating; the pulse tends to be soft and rapid. Representative Herbs: capillaris (yinchen), bamboo skin (zhuru), red atractylodes (cangzhu), atractylodes (baizhu), hoelen (fuling), polyporus (zhuling), alisma (zexie), chih-shih (zhishi). Representative Formulas: Capillaris and Hoelen Five Formula (Yinchen Wuling San); Capillaris and Hoelen Four Formula (Yinchen Siling San). THE SPLEEN CANNOT CONTAIN THE BLOOD WITHIN THE VESSELS (pi bu tong xue): primary symptoms are general signs of spleen qi deficiency, such as pale face and tendency towards diarrhea, accompanied by signs of bleeding, such as blood in the stool, nose bleed, gum bleeding, subcutaneous bleeding (purpura),

increased amounts of menstrual bleeding or continuous spotting. Secondary symptoms may include other spleen deficiency symptoms, such as decreased appetite; fatigue, bloating after eating; shallow breathing or shortness of breath; cold extremities; skinny constitution. The tongue typically presents with a pale body and a white coating; the pulse tends to be soft, fine, and weak. Representative Herbs: codonopsis (dangshen), astragalus (huangqi), atractylodes (baizhu), tang-kuei (danggui), dioscorea (shanyao), lotus seed (lianzi), roasted ginger (paojiang), longan (longyanrou), baked licorice (zhi gancao). Representative Formula: Ginseng and Longan Combination (Guipi Tang).